Proclamation... The multiples of four are varied, as is mentioned in the following.

Various religious scriptural references have been taken from books and authors from all over the world, and a humble note of gratitude is offered in their great feet, with a quote...lives of great men, all remind uswe can make our lives sublime..and departing, leave behind usfoot-prints on the sands of timebecausethere aremiles to go before anyone wants to sleep...

The four vedas:-SamvedaRigvedaYajurvedaAtharvaveda

God Shiva being the personified form of all the four vedas, and also of the Upa-vedas, like Dhanurveda, Sthapatyaveda etc.

Lord Ram, and his brothers, Laxman, Bharat, Shatrughna or Kreeshna [Vasudev], Pradyumna, Sankarshan, Aniruddha being the other four designated names for the different personifications of the Vedas in different spans of Time or Eternity.

The four Ashrams headed by great ancient masters like Vallabh, Shankar, Ramanuj and Madhav.

They taught the four-fold freedom, from the effects of Time, action, nature, with or without the causal laws of meditation, dividing the average life-span of an ideal human being into hundred years, into two and a half decades each of learning, experiencing married-life, with ancestral pilgrimages to shrines and temples, to renouncing everything to feel 'from dust to dust......'

The love grows step-by-step from acquaintance, to liking, to obsession, to passion till one reaches a stage wherein..'the worshipper himself becomes worth worshipping....'

All such knowledge, like the news, north-east-west-south, as in the four directions, belongs to any or all who can be bothered to take the initiative to untangle this bequeathed legacy to us, since anything written anywhere in black and white could be as useless as tissue paper because the Truth always sets anybody Free.

Hence, freedom being freedom, liberty being liberty, and God naturally being the Generalization, or conceptualization or the abstraction of learnt and proven application of experience by observing, reflecting, sharing, comparing and processing the information, very much like in a fresh-fruit juicer....enjoy Urself..

P.S. : For those who hadasked questions about AIDS, the following is taken from an article by Andrea Kovacs, MD Associate Professor of Pediatrics and Pathology, University of Southern California, Keck School of Medicine, Los Angeles, California; Head, Division of Infectious Diseases, Department of Pediatrics, Los Angeles County/USC Medical Center, Los Angeles, California

You bring up an extremely important issue related to perinatal transmission of HIV and probably other viruses as well. Several studies have documented an association between perinatal transmission and with prolonged rupture of membranes (PROM, especially when it is associated with long labor. Studies on the timing of infection that were carried out before the advent of highly active antiretroviral therapy (HAART) suggest that about 80% of infants are infected near delivery. This is thought to occur either through maternal-fetal transfusion during labor or through direct contact with infectious virus in genital secretions, direct contact with blood, or because of manipulations that cause the skin to break. These data suggest that obstetrical factors may have an important influence on transmission. One large substudy of the Women and Infants Transmission Study (WITS) assessed the relationship between length of time from ROM to delivery and perinatal transmission of HIV-1.[1] Among the 525 women assessed, it was found that if membranes were ruptured for more than 4 hours before delivery, 25% of infants became infected; when ROM occurred less than 4 hours before delivery, only 14% became infected. Women who had ruptured membranes for more than 4 hours had a 2-fold increase in risk of transmission of HIV to their infants (odds ratio [OR], 1.82; 95% confidence interval [CI], 1.10-3.00; P = .02) , regardless of the mode of delivery.

The second study -- the largest study to date done by the International Perinatal HIV Group -- is a meta-analysis that included both American and European prospective cohorts of at least 100 mother-child pairs. In this study of 4721 women, only patients who delivered vaginally with duration of ROM of 24 hours or less were included, and all elective cesarean sections were excluded.[2] This study confirmed that length of ROM is closely associated with risk of vertical HIV transmission. There was a 2% increase with each hour in the duration of ruptured membranes (adjusted OR, 1.02; 95% CI, 1.01-1.04) . This was even more significant for women with AIDS who had increases in probability of transmission that ranged from 8% for 2-hour ROM to 31% with 24-hour ROM. Another observational study done in France involved 2834 women, 902 of whom received zidovudine during pregnancy.[3] This study also confirmed that ROM 4 hours or more before delivery was associated with increased risk of transmission.

Two recent large randomized trials of perinatal transmission analyzed the independent contribution of ROM > 4 hours in patients receiving antiretroviral therapy. The first study compared oral dosing of short-course nevirapine with multiple-dose zidovudine/lamivudine for women who present in labor. In this study, PROM was associated with a marginally increased risk of transmission (multivariate OR, 2.8; 95% CI, 0.9-7.9; P = .06) .[4] In a second study just recently published, women were treated with a single dose of oral nevirapine and their infants were treated with either 2 mg/kg of nevirapine or with the same dose of nevirapine plus 4 mg/kg of zidovudine twice daily for 1 week. PROM did not appear to affect transmission in this study (adjusted OR, 0.97; 95% CI, 0.59-1.60; P = .91) and the transmission rates were 8.1% and 10.1% at birth and 14.1% and 16.3%, respectively, for infants treated with nevirapine alone and those treated with nevirapine plus zidovudine.[5]

Finally, mode of delivery has also been associated with risk of perinatal transmission. This was nicely demonstrated in 2 large studies. The first was a recent meta-analysis of data from 8533 mother-child pairs, again from the International Perinatal HIV Group, which found a 50% decreased risk of perinatal transmission among women who had an elective cesarean section. When combined with prenatal, intrapartum, and neonatal antiretroviral therapy, the risk of transmission decreased by 87%.[6] The second study, the European Mode of Delivery Collaboration study, was a randomized clinical trial which also confirmed a reduction in transmission risk among women who underwent elective cesarean section.[7] Whether cesarean section gives additional benefit when viral load is undetectable following administration of HAART is uncertain, since the rates of transmission using HAART -- and even standard zidovudine plus single-dose nevirapine -- are well below 1% to 2%.[8, 9]

In the particular situation you present, treatment has not adequately decreased viral load because your patient has only received 3 doses of HAART. She also has had PROM. However, she has not been in labor, during which there is increased maternal-fetal transfusion. Thus, the risk in this baby is mostly related to exposure through contact with HIV in the maternal vaginal vault. We have shown a high correlation between genital shedding[10] of HIV and plasma viral load, and of course plasma viral load levels correlate with transmission.[11] This mother most likely is shedding HIV at relatively high levels since her plasma viral load is > 100, 000 copies/mL and the baby is at high risk for infection because of high maternal HIV RNA, probably high genital HIV RNA, and PROM. Thus, the risk of transmission is probably comparable to that seen in the studies done with single-dose nevirapine. Studies have shown no benefit to the addition of nevirapine when women are taking HAART during pregnancy, but it has just been shown that there is an additional benefit when nevirapine is added to the zidovudine regimen standardized by AIDS Clinical Trials Group Protocol 076.[9, 12] My suggestion would be to continue the HAART regimen in the mother. At our center we would provide equally aggressive treatment with 3 drugs for the baby. We use zidovudine, lamivudine, and nevirapine. Although there are no data as to the optimal length of treatment, we have always continued for 6 weeks when the mother has had little prenatal care and no real antiretroviral therapy. However, recent studies indicate that a shorter course may be acceptable.

O Maha Mrutunjaya, O maheshwaraThou art the ConcealedConned into camouflaging Thyself thusdisused, disgusted, with the disguise of diabolicsdieticians dermatologists doctors or donkeysThou the only Protector?destroyer turned the mask or the Face Off - a hollywood filmJohn Travolta love you for the way you act..Kindlyaccept these as humble offeringsOf all those who are indolent, indifferent or plainlylazy and caught sleepingnaturally off-guard thatMaheshwarais the most Gracious Godalso known by the following Vedic metresdialectic deductions or mistakes in translatingcould be errors of printing, nothing elsehence, Om Jum SahaOm Houn Jum SahaHreem aum namaha shivaay hreemaum jum saha palaya palayaum jum shah mam paaalay paalayaOm jum saha mam palay palay saha jum aum jum sahaThank you lordIt could have been worse...love you darlin'back to poetry, ...nonsensical ubiquitous obsequiousnesshowever great saintsrealizing that in this agewhere life-span itself is shortened, the first two - twelve years go for educationthe next - i.e., till 24 should go for learningtill 48 should be a married life, till 60 travelling on pilgrimages and meeting with the great thinkers of all civilizations, their view of benevolence...which ideally should effortlessly induce, incite or 'simply for gags'..happy?

To send a private email message to the doc...
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